Comparative Study of the Antioxidant Activity of the Plasma of Healthy Subjects and those with Uterine Myomas by Scavenging the ABTS Radical+

Introduction: The oxidative stress and the deterioration of the antioxidant system demonstrated by the dosage of antioxidant enzymes and the by-products of lipid peroxidation are involved in the occurrence of uterine myomas. Objectives: To measure the antioxidant activity of the plasma of patients with uterine myoma and that of the plasma of their age-matched controls by trapping the free radical ABTS+. The study aims to confirm by another assessment technique. Results: The anti-free radical activities of the plasmas of patients with myomas and those of their respective controls vary from 1.3 to 6%. In addition, two cases were observed: either the anti-radical activity of the control subjects turned out to be slightly higher than that of the patients; or the anti-free radical activity of patients with uterine myomas was slightly stronger than those of their controls. In addition, our results showed that the anti-free radical activity of patients aged over 40 years is slightly higher than that of patients aged less than or equal to 40 years. Finally, the anti-free radical activity decreases with an increase in BMI and increases with the number of gestities and parity. Conclusion: Assessment of the total antioxidant capacity of blood by trapping the ABTS+ radical can be used to assess, at a certain threshold, the oxidative stress involved in the development of uterine myoma. This method can also be used to assess the effect of age, BMI, pregnancy and parity on the occurrence of myomas.

Urgent gynecology: a new look

To improve the diagnostics and treatment of urgent gynecological diseases 1000 patients with the pathology were examined. 700 women were subjected to laparoscopy. The following structure of acute gynecological diseases was defined: 47% ectopic pregnancy, 24% acute inflammatory diseases of adnexa uteri, 17% ovarian apoplexy, 7% torsion of ovarian cyst pedicle, 4% uterine myoma associated with the disturbances of alimentation of the ganglion, 1% perforation of the uterus. On the basis of the analysis of complains, anamnesis, clinical symptoms and results of supplementary examinations the algorithm of management of patients with suspected acute gynecological diseases including diagnostic laparoscopy was elaborated

Anesthesia Management in Intramural Uterine Myoma and Obesity Morbid Patients Who Underwent Myomectomy Perlaparatomy

Introduction. Obesity is a condition that increases the challenges in the surgical process. Obesity increases the risk of sleep apnea and affects anaesthetics. This case report aims to discuss the management of anaesthesia in a patient with morbid obesity. Case. Female, 26 years old, with intramural uterine myoma and morbid obesity, will undergo myomectomy per laparotomy with ASA II physical status, performed anaesthesia with general anaesthesia intubation technique using the anaesthetic agent Propofol 1-2.5 mg/kg titration until the patient falls asleep, fentanyl 1-2 mcg/kg, then the patient was intubated in a ramped position with sleep non-apnea. After it was confirmed that the ETT was entered, 30 mg of a muscle relaxant (atracurium) was added. The operation lasts 1 hour 30 minutes, with a bleeding 250 cc, hemodynamically stable. Conclusion. Morbid obesity has extraordinary implications for anaesthetic management. Various considerations for patients with morbid obesity are needed starting from the preoperative, intraoperative, to postoperative periods. Regional anaesthesia is preferred because the physiological function of unhealthy obese patients is impaired due to excess body weight. Selection of anaesthetic agent and calculation of drug dose is crucial to know because there is a change in the volume of distribution. The pharmacokinetics of most general anaesthetics are affected by the adipose tissue mass, produce a prolonged drug effect, and less predictable.

Effect of Two Different Doses of Vitamin D Supplementation on Uterine Myoma on South East Iranian Population; A Clinical Trial

Objective: Uterine myoma is the most common benign tumor however with significant distress and reduced quality of life in affected women. Besides, vitamin D deficiency may be a risk factor for uterine myoma. This study aimed to evaluate the effect of vitamin D supplements on the size of myoma in women with vitamin D insufficiency or deficiency. Materials and methods: This clinical trial was conducted in a teaching hospital from 2019 to 2020. According to baseline vitamin D level, participants were assigned into two interventional equal groups (vitamin D deficiency or insufficiency) to receive either 1000 IU daily or 50000 IU weekly vitamin D for 12 weeks. The size and location of the uterine myoma were compared before and after the intervention. Results: Totally, 137 women with uterine myoma were enrolled. Based on baseline vitamin D level, 52 cases had vitamin D insufficiency and 85 cases had vitamin D deficiency. No significant difference was observed in age and BMI in both groups. The location of the subserosal and intramural myoma did not differ, otherwise, the percent of the submucosal myomas were increased significantly (p=0.020) after the intervention. In both groups decreased myoma size otherwise not significant was seen after the intervention (p=0.148 and p=0.664 respectively). Conclusion: Vitamin D supplementation may not be effective in women with vitamin D insufficiency or deficiency in the short term to reduce myoma size.

Biomarkers of the type of recurrent uterine myoma-associated growth

Objective: To assess the diagnostic value of biomarkers: microbiological, molecular and biological, immunological biomarkers, characteristic of various types of recurrent myoma-associated growth.Materials and Methods: Seventy women of reproductive age with recurrent uterine myoma and its combination with adenomyosis after conservative treatment in the Clinic of Kuban State Medical University were examined. Methods: microbiological examination, sonography, Doppler sonography, histology, immunohistochemistry, morphometry.Results: The type of recurrent myoma-associated growth was proved to be dependent on molecular and biological characteristics of tumors, the presence of infection and blood perfusion. It was indicated that women with recurrence of myoma-associated growth of a “false” type were characterized by high rates of infections (the presence of reproductive losses, chronic inflammatory diseases of the pelvic organs) and significant bacterial contamination of the genital tract biotopes. Blood perfusion features were identified for true and “false” types of recurrent myoma-associated growth based on Doppler sonography data, which were consistent with features of tumor vessel morphometry. Analysis of uterine myoma histological types and their vascularization features showed correlation of forms with a high proliferative potential of a tumor on a molecular and cellular level to moderate and high expression of steroid hormone receptors in combination with Ki67, a significant diameter of the lumen of the vessels with the highest VI and VFI values.Conclusions: A comprehensive study of women with uterine hyperplasia determines the possibility of prediction of pathogenetic variants of recurrent myoma-associated tissue growth and adequate choice of treatment options and rehabilitation course.

Myomectomy or conservative management of uterine fibroids: effects on reproductive potential

AIM: The aim of this study was to analyze reproductive function, pregnancy and labor in women after laparoscopic myomectomy and in women with unoperated myoma. MATERIALS AND METHODS: The main group consisted of 60 patients aged 25-46 years with a scar on the uterus who had laparoscopic myomectomy. Inclusion criteria were full-term pregnancy, uterine scar after laparoscopic myomectomy for subserosal or intramural uterine myoma (3-10 cm), and myomatous nodules (one to three). The comparison group included 30 women aged 25-46 years who were not surgically treated. Inclusion criteria were full-term pregnancy, subserosal or intramural uterine myoma (3-10 cm), and myomatous nodules (one to three). All patients in the main group underwent laparoscopic myomectomy. In all cases, the myomatous nodule was removed intracapsularly, leaving the leiomyoma pseudocapsule, which, with a deep arrangement of the transmural myomatous nodules, avoided opening the uterine cavity; myomatous nodule morcellation being used. With a deep intramural arrangement of the leiomyoma, the myometrial defect was sutured layer by layer with the application of several rows of endosutures. RESULTS: Six months after myomectomy, the patients underwent MRI of their pelvic organs with contrast. In 95% of cases, the uterine scar had no anatomical insolvency. In assessing the anamnesis, gynecological diseases occurred two times more often in women in the main group: 22 (36.7%) patients resorted to the use of the in vitro fertilization method for pregnancy, while among the patients in the comparison group, there were only two (6.7%) of them (2 = 12.8; р 0.001). In the main group, moderate preeclampsia and gestational diabetes mellitus were twice as common. In the main group, all patients were delivered by caesarean section, of which 83.3% were planned and 16.7% were emergency. In the comparison group, 73.3% of patients were delivered through the natural birth canal and 26.7% by caesarean section (2 = 149, p 0.0001). The most unfavorable signs predisposing to obstetric complications and operative delivery were the presence of multiple nodules (OR = 5.96 (1.09-32.72), p 0.05), the location of the nodule or scar in the uterine bottom (OR = 2.52 (1.00-6.33), p 0.05), and their combination with IVF (OR = 9.09 (2.42-34.07), р 0.01). CONCLUSIONS: In 95% of women, the scar on the uterus after myomectomy was consistent, but all these pregnant women were delivered by cesarean section, mainly for combined indications. However, they carried out the pregnancy safely, with a good outcome for the fetus. In women with uterine myoma and its conservative management, there was a lower rate of aggravated gynecological history and obstetric complications, and 73.3% of them were delivered through the natural birth canal. Despite the increased risk of caesarean section, the presence of uterine fibroids, even of a large size (more than 4 cm), should not be considered as a contraindication to vaginal delivery.

Large Tricuspid Valve Myxoma in an Asymptomatic Patient with Uterine Myoma: An Uncommon Case

Tricuspid valve myxomas are very uncommon tumors that could be found after the occurrence of pulmonary thromboembolism, symptomatic tricuspid obstruction, and right-sided heart failure. Herein, we describe a 42-year-old woman evaluated for an abdominal mass. In preoperative consultation, a tricuspid valve mass was detected in echocardiography. She underwent the removal of a benign uterine myoma and a myxoma of the tricuspid valve. Tricuspid valve myxomas constitute a scarce diagnosis. They could be asymptomatic, occurring in unusual locations and in association with benign tumors in other organs. Our patient was asymptomatic, underscoring the significance of the early diagnosis of this type of tumor to prevent further catastrophic events.